| NPI | 1144300013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME112995) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL29212) |
| 208000000X Pediatrics (Licence: OH 35.093446) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2012-07-09 |